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Greer R, von Wirth T, Loorbach D. The Circular Decision-Making Tree: an Operational Framework. Circ Econ Sustain 2022; 3:1-26. [PMID: 36157592 PMCID: PMC9491253 DOI: 10.1007/s43615-022-00194-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 06/28/2022] [Indexed: 11/08/2022]
Abstract
Because of the need to limit extraction of raw materials and reduce amounts and impacts of waste, countries and businesses are challenged to transition to a circular economy: an economic system in which the materials are reduced, reused, or recycled, but not wasted. Yet, transitioning from a linear to a circular economy implies societal-level, structural changes that have deep implications for existing business models and practices-and the current economic system is still largely organized around virgin material extraction and linear modes of production and consumption. Despite stated ambitions at various geographical scales to become more or fully circular, the outcomes still fall short of such visions. One important reason why the transition towards a circular economy is not proceeding as quickly as hoped can be found in the decision processes used by companies, investors, and policy makers. Suitable frameworks that support decision-making could thus be a key enabler of this transition, if based upon a circular and transformative, rather than a linear optimization logic. In this paper, we therefore explore a different decision-making logic that is developed based on circularity. This provides the basis for an operational framework designed to help decision-makers such as policymakers, investors, and entrepreneurs navigate tradeoffs and take decisions considering the quality of innovation circularity and its respective diffusion potential. To develop, test, and refine our framework-the "Circular Decision-Making Tree"-we synthesized insights from existing frameworks and conceptually integrated these with our understanding of transition theory and the circular economy. We then verified the internal logics and applicability of the framework in a series of usability workshops across four application contexts (Netherlands, Brazil, UK, and South Africa) with feedback from a total of n = 50 stakeholders from policy, practice, and academia. We critically discuss the application potential as well as the limitations and describe implications for future research to further validate the framework's logics and operationalization.
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Affiliation(s)
- Rachel Greer
- Dutch Research Institute for Transitions (DRIFT), Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Timo von Wirth
- Dutch Research Institute for Transitions (DRIFT), Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Derk Loorbach
- Dutch Research Institute for Transitions (DRIFT), Erasmus University Rotterdam, Rotterdam, Netherlands
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Hebinck A, Diercks G, von Wirth T, Beers PJ, Barsties L, Buchel S, Greer R, van Steenbergen F, Loorbach D. An actionable understanding of societal transitions: the X-curve framework. Sustain Sci 2022; 17:1009-1021. [PMID: 35069918 PMCID: PMC8764493 DOI: 10.1007/s11625-021-01084-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 12/12/2021] [Indexed: 06/14/2023]
Abstract
UNLABELLED Sustainability transition research seeks to understand the patterns and dynamics of structural societal change as well as unearth strategies for governance. However, existing frameworks emphasize innovation and build-up over exnovation and break-down. This limits their potential in making sense of the turbulent and chaotic dynamics of current transition-in-the-making. Addressing this gap, our paper elaborates on the development and use of the X-curve framework. The X-curve provides a simplified depiction of transitions that explicitly captures the patterns of build-up, breakdown, and their interactions. Using three cases, we illustrate the X-curve's main strength as a framework that can support groups of people to develop a shared understanding of the dynamics in transitions-in-the-making. This helps them reflect upon their roles, potential influence, and the needed capacities for desired transitions. We discuss some challenges in using the X-curve framework, such as participants' grasp of 'chaos', and provide suggestions on how to address these challenges and strengthen the frameworks' ability to support understanding and navigation of transition dynamics. We conclude by summarizing its main strength and invite the reader to use it, reflect on it, build on it, and judge its value for action research on sustainability transitions themselves. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s11625-021-01084-w.
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Affiliation(s)
- Aniek Hebinck
- Dutch Research Institute for Transitions (DRIFT), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Gijs Diercks
- Dutch Research Institute for Transitions (DRIFT), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Timo von Wirth
- Dutch Research Institute for Transitions (DRIFT), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Social and Behavioural Sciences (ESSB), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - P. J. Beers
- Dutch Research Institute for Transitions (DRIFT), Erasmus University Rotterdam, Rotterdam, The Netherlands
- HAS University of Applied Sciences, ‘s Hertogenbosch, The Netherlands
| | - Lisa Barsties
- Dutch Research Institute for Transitions (DRIFT), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sophie Buchel
- Dutch Research Institute for Transitions (DRIFT), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Rachel Greer
- Dutch Research Institute for Transitions (DRIFT), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Social and Behavioural Sciences (ESSB), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Frank van Steenbergen
- Dutch Research Institute for Transitions (DRIFT), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Derk Loorbach
- Dutch Research Institute for Transitions (DRIFT), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Social and Behavioural Sciences (ESSB), Erasmus University Rotterdam, Rotterdam, The Netherlands
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Tipler AE, Moses EA, Greer R, Delisser P, McCracken BD, Moses PA. Urinary catheterisation of female dogs: a comparison between three techniques for catheter placement. Aust Vet J 2020; 98:364-370. [PMID: 32458428 DOI: 10.1111/avj.12961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/26/2020] [Accepted: 04/26/2020] [Indexed: 12/01/2022]
Abstract
The objective of this study was to describe a new technique for urinary catheterisation of female dogs using a novel catheterisation device (NCD) and to compare the time taken to place a catheter using this technique with traditional techniques. A secondary objective was to survey participants on which of the techniques they preferred. Female canine cadavers of varying sizes were utilised and veterinary students who had not previously placed a urinary catheter were enrolled. Each participant performed three catheterisation techniques, Visual with speculum (SPEC), Blind Palpation (BP) and catheterisation with NCD on three sizes of dog. Time required using each technique was compared using Kaplan-Meier plots and mixed models Cox Proportional Hazards regression. Median times to catheterisation were 300 s (IQR 261-417 s) with the SPEC method, 420 s (IQR 253-545 s) with the NCD method and 725 s (574-1032s) with the BP method. Both SPEC and NCD methods were significantly faster compared to the BP method, with Hazard Ratios of 3.66 (95% CI 1.94-6.91, P < 0.001) and 3.57 (95% CI 1.87-6.81, P < 0.001), respectively. Six of nine participants found the NCD the easiest technique, 5/9 of the participants found the palpation technique most difficult and 4/9 found the speculum technique most difficult. BP appears to be the technique of least preference and increased time requirement. The novel urinary catheterisation device may provide a simpler method of visualisation of the urethral papilla and may provide a more sterile way of placing the catheter, although further investigation is needed to confirm this.
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Affiliation(s)
- A E Tipler
- Surgical Resident at Veterinary Specialist Services, 24/34 Goggs Road, Jindalee, Queensland, 4074, Australia
| | - E A Moses
- PhD Candidate and Research Assistant, University of Queensland, St Lucia, 4067, Australia
| | - R Greer
- Epidemiologist at Torus Research, 1026 Beams Rd, Bridgeman Downs, Queensland, 4035, Australia
| | - P Delisser
- Specialist surgeon at Veterinary Specialist Services, 24/34 Goggs Road, Jindalee, Queensland, 4074, Australia
| | - B D McCracken
- Surgical Registrar at Western Australian Veterinary Emergency and Specialty, 1/640 Beeliar Drive, Success, Western Australia, 6164, Australia
| | - P A Moses
- Director at Veterinary Specialist Services, 24/34 Goggs Road, Jindalee, Queensland, 4074, Australia
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Elisofon SA, Magee JC, Ng VL, Horslen SP, Fioravanti V, Economides J, Erinjeri J, Anand R, Mazariegos GV, Martin A, Mannino D, Flynn L, Mohammad S, Alonso E, Superina R, Brandt K, Riordan M, Lokar J, Ito J, Elisofon S, Zapata L, Jain A, Foristal E, Gupta N, Whitlow C, Naik K, Espinosa H, Miethke A, Hawkins A, Hardy J, Engels E, Schreibeis A, Ovchinsky N, Kogan‐Liberman D, Cunningham R, Malik P, Sundaram S, Feldman A, Garcia B, Yanni G, Kohli R, Emamaullee J, Secules C, Magee J, Lopez J, Bilhartz J, Hollenbeck J, Shaw B, Bartow C, Forest S, Rand E, Byrne A, Linguiti I, Wann L, Seidman C, Mazariegos G, Soltys K, Squires J, Kepler A, Vitola B, Telega G, Lerret S, Desai D, Moghe J, Cutright L, Daniel J, Andrews W, Fioravanti V, Slowik V, Cisneros R, Faseler M, Hufferd M, Kelly B, Sudan D, Mavis A, Moats L, Swan‐Nesbit S, Yazigi N, Buranych A, Hobby A, Rao G, Maccaby B, Gopalareddy V, Boulware M, Ibrahim S, El Youssef M, Furuya K, Schatz A, Weckwerth J, Lovejoy C, Kasi N, Nadig S, Law M, Arnon R, Chu J, Bucuvalas J, Czurda M, Secheli B, Almy C, Haydel B, Lobritto S, Emand J, Biney‐Amissah E, Gamino D, Gomez A, Himes R, Seal J, Stewart S, Bergeron J, Truxillo A, Lebel S, Davidson H, Book L, Ramstack D, Riley A, Jennings C, Horslen S, Hsu E, Wallace K, Turmelle Y, Nadler M, Postma S, Miloh T, Economides J, Timmons K, Ng V, Subramonian A, Dharmaraj B, McDiarmid S, Feist S, Rhee S, Perito E, Gallagher L, Smith K, Ebel N, Zerofsky M, Nogueira J, Greer R, Gilmour S, Robert C, Cars C, Azzam R, Boone P, Garbarino N, Lalonde M, Kerkar N, Dokus K, Helbig K, Grizzanti M, Tomiyama K, Cocking J, Alexopoulos S, Bhave C, Schillo R, Bailey A, Dulek D, Ramsey L, Ekong U, Valentino P, Hettiarachchi D, Tomlin R. Society of pediatric liver transplantation: Current registry status 2011-2018. Pediatr Transplant 2020; 24:e13605. [PMID: 31680409 DOI: 10.1111/petr.13605] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/08/2019] [Accepted: 09/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND SPLIT was founded in 1995 in order to collect comprehensive prospective data on pediatric liver transplantation, including waiting list data, transplant, and early and late outcomes. Since 2011, data collection of the current registry has been refined to focus on prospective data and outcomes only after transplant to serve as a foundation for the future development of targeted clinical studies. OBJECTIVE To report the outcomes of the SPLIT registry from 2011 to 2018. METHODS This is a multicenter, cross-sectional analysis characterizing patients transplanted and enrolled in the SPLIT registry between 2011 and 2018. All patients, <18 years of age, received a first liver-only, a combined liver-kidney, or a combined liver-pancreas transplant during this study period. RESULTS A total of 1911 recipients from 39 participating centers in North America were registered. Indications included biliary atresia (38.5%), metabolic disease (19.1%), tumors (11.7%), and fulminant liver failure (11.5%). Greater than 50% of recipients were transplanted as either Status 1A/1B or with a MELD/PELD exception score. Incompatible transplants were performed in 4.1%. Kaplan-Meier estimates of 1-year patient and graft survival were 97.3% and 96.6%. First 30 days of surgical complications included reoperation (31.7%), hepatic artery thrombosis (6.3%), and portal vein thrombosis (3.2%). In the first 90 days, biliary tract complications were reported in 13.6%. Acute cellular rejection during first year was 34.7%. At 1 and 2 years of follow-up, 39.2% and 50.6% had normal liver tests on monotherapy (tacrolimus or sirolimus). Further surgical, survival, allograft function, and complications are detailed.
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Affiliation(s)
- Scott A Elisofon
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts
| | - John C Magee
- Division of Surgery, University of Michigan Transplant Center, Ann Arbor, Michigan
| | - Vicky L Ng
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Simon P Horslen
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Vicki Fioravanti
- Section of Hepatology and Liver Transplantation, Children's Mercy Hospital, Kansas City, Missouri
| | | | | | | | - George V Mazariegos
- Division of Pediatric Transplant Surgery, Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Greer R, Althaus T, Ling C, Intralawan D, Nedsuwan S, Thaipadungpanit J, Wangrangsimakul T, Butler C, Day N, Lubell Y. Prevalence of Group A Streptococcus in Primary Care Patients and the Utility of C-Reactive Protein and Clinical Scores for Its Identification in Thailand. Am J Trop Med Hyg 2020; 102:377-383. [PMID: 31889507 PMCID: PMC7008346 DOI: 10.4269/ajtmh.19-0502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/11/2019] [Indexed: 01/21/2023] Open
Abstract
Pharyngitis is usually caused by a viral infection for which antibiotics are often unnecessarily prescribed, adding to the burden of antimicrobial resistance. Identifying who needs antibiotics is challenging; microbiological confirmation and clinical scores are used but have limitations. In a cross-sectional study nested within a randomized controlled trial, we estimated the prevalence and antibiotic susceptibility profiles of group A Streptococcus (GAS) in patients presenting to primary care with a sore throat and fever in northern Thailand. We then evaluated the use of C-reactive protein (CRP) and clinical scores (Centor and FeverPAIN) to identify the presence of GAS. One hundred sixty-nine patients were enrolled, of whom 35 (20.7%) had β-hemolytic Streptococci (BHS) isolated from throat swab culture, and 11 (6.5%) had GAS. All GAS isolates were sensitive to penicillin G. The median CRP of those without BHS isolation was 10 mg/L (interquartile range [IQR] ≤ 8-18), compared with 18 mg/L (IQR 9-71, P = 0.0302) for those with GAS and 14 mg/L (IQR ≤ 8-38, P = 0.0516) for those with any BHS isolated. However, there were no significant relationships between CRP > 8 mg/L (P = 0.112), Centor ≥ 3 (P = 0.212), and FeverPAIN ≥ 4 (P = 1.000), and the diagnosis of GAS compared with no BHS isolation. Identifying who requires antibiotics for pharyngitis remains challenging and necessitates further larger studies. C-reactive protein testing alone, although imperfect, can reduce prescribing compared with routine care. Targeted CRP testing through clinical scoring may be the most cost-effective approach to ruling out GAS infection.
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Affiliation(s)
- Rachel Greer
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Thomas Althaus
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Clare Ling
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Daranee Intralawan
- Social and Preventive Medicine Department, Chiang Rai Regional Hospital, Chiang Rai, Thailand
| | - Supalert Nedsuwan
- Social and Preventive Medicine Department, Chiang Rai Regional Hospital, Chiang Rai, Thailand
| | - Janjira Thaipadungpanit
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Tri Wangrangsimakul
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Christopher Butler
- Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Nicolas Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Yoel Lubell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
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Greer R, Gutierrez H, Maricle D, Miller D. C-26A Comparative Evaluation in Executive Function Assessment: A Closer Look at the Monitoring Indices of the BRIEF and CEFI within a Mixed Clinical Population. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sykes BW, Underwood C, Greer R, McGowan CM, Mills PC. The effects of dose and diet on the pharmacodynamics of omeprazole in the horse. Equine Vet J 2016; 49:525-531. [DOI: 10.1111/evj.12630] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 08/19/2016] [Indexed: 12/13/2022]
Affiliation(s)
- B. W. Sykes
- School of Veterinary Science; The University of Queensland; Gatton Australia
| | - C. Underwood
- School of Veterinary Science; The University of Queensland; Gatton Australia
| | - R. Greer
- School of Veterinary Science; The University of Queensland; Gatton Australia
| | - C. M. McGowan
- Institute of Ageing and Chronic Disease; University of Liverpool; Liverpool UK
| | - P. C. Mills
- School of Veterinary Science; The University of Queensland; Gatton Australia
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Greer R, Longoria J, Maricle D, Miller D. C-66Examining the Academic Impact of Pediatric Neurological Impairment: Are There Group Differences in Reading, Writing, and Math? Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Greer R, Harvey S. OPTIMISATION OF PHARMACY CONTENT IN PAEDIATRIC ONCOLOGY AND HAEMATOLOGY CLINICAL TRIAL PROTOCOLS. EXPERIENCE OF CHEMOTHERAPY PHARMACY ADVISORY SERVICE (CPAS) FROM 2011 TO PRESENT. Arch Dis Child 2016; 101:e2. [PMID: 27540253 DOI: 10.1136/archdischild-2016-311535.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM Clarity and accuracy of the pharmacy aspects of cancer clinical trial protocols is essential. Inconsistencies and ambiguities in protocols have the potential to delay research and jeopardise both patient safety and the collection of credible data. The Chemotherapy and Pharmacy Advisory Service (CPAS) was established in 2007 by the UK National Cancer Research Network, currently known as National Institute for Health Research Clinical Research Network, to improve the quality of pharmacy-related content in cancer clinical trial protocols. This abstract describes the scope of CPAS, its methodology of mandated protocol review and an analysis of the issues found and reported in paediatric oncology and haematology trials. METHOD All paediatric oncology and haematology clinical trial protocols from 2011 to present were included in this study. A review checklist was developed by CPAS and used by the review panel, consisting of pharmacists, doctors and nurses, to standardise the evaluation of all protocols. Once completed, all reviews were collated and any queries and inconsistencies were fed back to Chief Investigators and study sponsors. The most common remarks made at protocol review were summarised and categorised through retrospective analysis. It is at the discretion of the study Sponsor and Chief Investigator to accept any recommendations or amendments based on the findings. In order to evaluate the impact of the service, Chief Investigators were asked to respond to queries made at protocol review and make appropriate changes to their protocols. Responses from Chief Investigators have been collated and acceptance rates determined. RESULTS A total of 13 paediatric protocols were reviewed during this period. The mean number of comments per protocol was 32 and these mainly concerned the drug regimen, support medication, dose calculation, drug information and administration. Eleven of the Chief investigators returned responses to their protocols reviews. All responses were positive with an overall acceptance rate of 82% of the proposed protocol changes. CONCLUSION Review by CPAS of pharmacy content of paediatric oncology and haematology clinical trial protocols prior to final approval is feasible and exposes many undetected clinically relevant issues that could hinder efficient trial conduct and/or patient safety. This analysis has highlighted that the majority of suggestions were deemed clinically significant and effectively incorporated into the final protocols. The refinement of existing and development of further pharmacy-related guidance documents by CPAS might support more effective and safer clinical research.
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Longoria J, Greer R, Maricle D, Miller D. B-66Examining the Cognitive Impact of Neurological Insult in Pediatric Populations: Are There Group Differences in Attention, Processing Speed, and Working Memory? Arch Clin Neuropsychol 2016. [DOI: 10.1093/arclin/acw043.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Greer R, Daniel M, Maricle D. B-85Examining the Influence of Neurocognitive Constructs on Mathematical Ability. Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv047.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sykes BW, Underwood C, Greer R, McGowan CM, Mills PC. Pharmacokinetics and bioequivalence testing of five commercial formulations of omeprazole in the horse. J Vet Pharmacol Ther 2015; 39:78-83. [DOI: 10.1111/jvp.12240] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/23/2015] [Indexed: 11/27/2022]
Affiliation(s)
- B. W. Sykes
- School of Veterinary Sciences; The University of Queensland; Gatton Qld Australia
| | - C. Underwood
- School of Veterinary Sciences; The University of Queensland; Gatton Qld Australia
| | - R. Greer
- School of Veterinary Sciences; The University of Queensland; Gatton Qld Australia
| | - C. M. McGowan
- Institute of Ageing and Chronic Disease; University of Liverpool; Liverpool UK
| | - P. C. Mills
- School of Veterinary Sciences; The University of Queensland; Gatton Qld Australia
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Debruyne PR, Johnson PJ, Pottel L, Daniels S, Greer R, Hodgkinson E, Kelly S, Lycke M, Samol J, Mason J, Kimber D, Loucaides E, Parmar MK, Harvey S. Optimisation of pharmacy content in clinical cancer research protocols: Experience of the United Kingdom Chemotherapy and Pharmacy Advisory Service. Clin Trials 2015; 12:257-64. [PMID: 25652529 DOI: 10.1177/1740774515569610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Clarity and accuracy of the pharmacy aspects of cancer clinical trial protocols is essential. Inconsistencies and ambiguities in such protocols have the potential to delay research and jeopardise both patient safety and collection of credible data. The Chemotherapy and Pharmacy Advisory Service was established by the UK National Cancer Research Network, currently known as National Institute for Health Research Clinical Research Network, to improve the quality of pharmacy-related content in cancer clinical research protocols. This article reports the scope of Chemotherapy and Pharmacy Advisory Service, its methodology of mandated protocol review and pharmacy-related guidance initiatives and its current impact. Methods Over a 6-year period (2008–2013) since the inception of Chemotherapy and Pharmacy Advisory Service, cancer clinical trial protocols were reviewed by the service, prior to implementation at clinical trial sites. A customised Review Checklist was developed and used by a panel of experts to standardise the review process and report back queries and inconsistencies to chief investigators. Based on common queries, a Standard Protocol Template comprising specific guidance on drug-related content and a Pharmacy Manual Template were developed. In addition, a guidance framework was established to address ‘ad hoc’ pharmacy-related queries. The most common remarks made at protocol review have been summarised and categorised through retrospective analysis. In order to evaluate the impact of the service, chief investigators were asked to respond to queries made at protocol review and make appropriate changes to their protocols. Responses from chief investigators have been collated and acceptance rates determined. Results A total of 176 protocols were reviewed. The median number of remarks per protocol was 26, of which 20 were deemed clinically relevant and mainly concerned the drug regimen, support medication, frequency and type of monitoring and drug supply aspects. Further analysis revealed that 62% of chief investigators responded to the review. All responses were positive with an overall acceptance rate of 89% of the proposed protocol changes. Conclusion Review of pharmacy content of cancer clinical trial protocols is feasible and exposes many undetected clinically relevant issues that could hinder efficient trial conduct. Our service audit revealed that the majority of suggestions were effectively incorporated in the final protocols. The refinement of existing and development of new pharmacy-related guidance documents by Chemotherapy and Pharmacy Advisory Service might aid in better and safer clinical research.
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Affiliation(s)
- Philip R Debruyne
- Ageing & Cancer Research Cluster, Centre for Positive Ageing, University of Greenwich, London, UK Department of Adult Nursing & Paramedic Science, Faculty of Education & Health, University of Greenwich, London, UK Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Philip J Johnson
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Lies Pottel
- Ageing & Cancer Research Cluster, Centre for Positive Ageing, University of Greenwich, London, UK Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Susanna Daniels
- Pharmacy and Medicines Management, University College London Hospitals, London, UK
| | | | | | | | - Michelle Lycke
- Ageing & Cancer Research Cluster, Centre for Positive Ageing, University of Greenwich, London, UK Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Jens Samol
- St George's Hospital Healthcare NHS Trust, London, UK
| | - Julie Mason
- Sandwell and West Birmingham Hospitals NHS Trust, West Midlands, UK Pharmacy and Therapeutics, University of Birmingham, Birmingham, UK
| | - Donna Kimber
- Wessex Clinical Senate & Strategic Networks, NHS England, Southampton, UK
| | | | | | - Sally Harvey
- NIHR CPAS, National Institute for Health Research, Clinical Research Network Cancer Coordinating Centre, Leeds, UK
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Debruyne P, Johnson P, Pottel L, Daniels S, Greer R, Hodgkinson E, Kelly S, Lycke M, Samol J, Simpson J, Kimber D, Loucaides E, Parmar M, Harvey S. The United Kingdom (Uk) National Cancer Research Network (Ncrn) Chemotherapy and Pharmacy Advisory Service (Cpas): Service Development and Quality Control Experience of Pharmacy Aspects in Clinical Research Protocols. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu353.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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McCoy A, Greer R, Prince L. Induction of ectopic inflammasome function in fetal lung mesenchyme (715.4). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.715.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alyssa McCoy
- Neuroscience and Pharmacology Meharry Medical CollegeNashvilleTNUnited States
- Pediatrics University of California, San DiegoLA JollaCAUnited States
| | - Rachel Greer
- Pediatrics University of California, San DiegoLA JollaCAUnited States
| | - Lawrence Prince
- Pediatrics University of California, San DiegoLA JollaCAUnited States
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16
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Greer R, Prince L. Bacterial lipopolysaccharide inhibits VEGFR2 expression and cell migration in fetal mouse lung mesenchyme (540.1). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.540.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Lawrence Prince
- Neonatology Rady Children's HospitalSan DiegoCAUnited States
- Pediatrics UC San DiegoLA JollaCAUnited States
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17
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Girard L, Peyton M, Wistuba I, Xie Y, Greer R, Suraokar MB, Behrens C, Xiao G, Heymach J, Wheeler DA, Davis CF, Huffman K, Shames DS, Coombes KR, Gazdar AF, Lam DCL, Beer DG, Minna JD. Abstract 5589: Molecular signatures of in vitro drug response in lung cancer. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-5589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
We are developing in vitro drug response signatures based on profiling of mRNA (Illumina WG6-V3 arrays), DNA mutation (COSMIC and deep sequencing), DNA copy number (Illumina Human1M-Duov3 SNP array) and DNA methylation (Illumina HumanMethylation450) from lung cancer cell lines to predict which drugs a patient's tumor is most likely to respond to. We have generated drug response phenotypes (MTS colorimetric assays) for ∼25 standard, targeted, and new chemotherapy agents and combinations for ∼ 100 non-small cell lung cancer (NSCLC) lines. All assays were done in triplicates or more and were very reproducible over time (r > 0.8). More than 10,000 MTS assays were generated and we designed a high-throughput database software named DIVISA (Database of In VItro Sensitivity Assays) for the purpose of storing and analyzing these assays. Some drugs showed a wide range of sensitivities (> 10,000-fold in IC50 values) and IC50 clustering indicates that drug response phenotypes can be grouped according to drug types. As part of a joint NCI SPORE, NCI SPECS, and DOD PROSPECT effort we have collected 275 clinically annotated frozen tumors with drug response information including 94 that represent lung cancer resection followed by adjuvant treatment. These specimens have also been profiled on Illumina expression arrays to formally test the clinical relevance of the tumor cell line signatures, and to verify that the signatures predict for response only in the presence of treatment and thus are not prognostic of survival in the absence of treatment. In addition, we have 3 primary tumor datasets totaling 96 specimens with EGFR mutation information, thus providing a validation set for EGFR tyrosine kinase inhibitor signatures. Using a weighted voting classification, cell line signatures predicted drug response in primary tumors with accuracies of ∼65% for targeted therapy (EGFR) but with somewhat lower accuracies for platin/taxane therapies suggesting that cell line predictive signatures may be better suited for targeted drugs. To facilitate translation to clinical trials we are working with High Throughput Genomics (HTG) to develop quantitative mRNA profiles that are performed on formalin fixed paraffin embedded (FFPE) material on a platform that can be transferred to a CLIA certified environment. These studies thus provide a preclinical human tumor model platform for systematically testing new drugs and for developing signatures to guide their most efficient use in early clinical tests. Funded by University of Texas SPORE in Lung Cancer (P50CA70907) and NCI SPECS Lung Cancer (CA114771).
Citation Format: Luc Girard, Michael Peyton, Ignacio Wistuba, Yang Xie, Rachel Greer, Milind B. Suraokar, Carmen Behrens, Guanghua Xiao, John Heymach, David A. Wheeler, Caleb F. Davis, Kenneth Huffman, David S. Shames, Kevin R. Coombes, Adi F. Gazdar, David CL Lam, David G. Beer, John D. Minna. Molecular signatures of in vitro drug response in lung cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 5589. doi:10.1158/1538-7445.AM2013-5589
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Affiliation(s)
- Luc Girard
- 1UT Southwestern Medical Center, Dallas, TX
| | | | | | - Yang Xie
- 1UT Southwestern Medical Center, Dallas, TX
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18
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Du L, Subauste MC, DeSevo C, Zhao Z, Baker M, Borkowski R, Schageman JJ, Greer R, Yang CR, Suraokar M, Wistuba II, Gazdar AF, Minna JD, Pertsemlidis A. miR-337-3p and its targets STAT3 and RAP1A modulate taxane sensitivity in non-small cell lung cancers. PLoS One 2012; 7:e39167. [PMID: 22723956 PMCID: PMC3377607 DOI: 10.1371/journal.pone.0039167] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 05/17/2012] [Indexed: 12/14/2022] Open
Abstract
NSCLC (non-small cell lung cancer) often exhibits resistance to paclitaxel treatment. Identifying the elements regulating paclitaxel response will advance efforts to overcome such resistance in NSCLC therapy. Using in vitro approaches, we demonstrated that over-expression of the microRNA miR-337-3p sensitizes NCI-H1155 cells to paclitaxel, and that miR-337-3p mimic has a general effect on paclitaxel response in NSCLC cell lines, which may provide a novel adjuvant strategy to paclitaxel in the treatment of lung cancer. By combining in vitro and in silico approaches, we identified STAT3 and RAP1A as direct targets that mediate the effect of miR-337-3p on paclitaxel sensitivity. Further investigation showed that miR-337-3p mimic also sensitizes cells to docetaxel, another member of the taxane family, and that STAT3 levels are significantly correlated with taxane resistance in lung cancer cell lines, suggesting that endogenous STAT3 expression is a determinant of intrinsic taxane resistance in lung cancer. The identification of a miR-337-3p as a modulator of cellular response to taxanes, and STAT3 and RAP1A as regulatory targets which mediate that response, defines a novel regulatory pathway modulating paclitaxel sensitivity in lung cancer cells, which may provide novel adjuvant strategies along with paclitaxel in the treatment of lung cancer and may also provide biomarkers for predicting paclitaxel response in NSCLC.
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Affiliation(s)
- Liqin Du
- Greehey Children's Cancer Research Institute, UT Health Science Center at San Antonio, San Antonio, Texas, United States of America
- Department of Cellular and Structural Biology, UT Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Maria C. Subauste
- McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Christopher DeSevo
- Division of Basic Sciences, Southwestern Graduate School of Biomedical Sciences, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Zhenze Zhao
- Greehey Children's Cancer Research Institute, UT Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Michael Baker
- Division of Basic Sciences, Southwestern Graduate School of Biomedical Sciences, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Robert Borkowski
- Division of Basic Sciences, Southwestern Graduate School of Biomedical Sciences, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Jeoffrey J. Schageman
- McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Rachel Greer
- Division of Basic Sciences, Southwestern Graduate School of Biomedical Sciences, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Chin-Rang Yang
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Milind Suraokar
- Department of Pathology, UT MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Ignacio I. Wistuba
- Department of Pathology, UT MD Anderson Cancer Center, Houston, Texas, United States of America
- Department of Thoracic/Head and Neck Medical Oncology, UT MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Adi F. Gazdar
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, United States of America
- Hamon Center for Therapeutic Oncology Research, UT Southwestern Medical Center, Dallas, Texas, United States of America
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - John D. Minna
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, United States of America
- Hamon Center for Therapeutic Oncology Research, UT Southwestern Medical Center, Dallas, Texas, United States of America
- Department of Pharmacology, UT Southwestern Medical Center, Dallas, Texas, United States of America
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, United States of America
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, United States of America
| | - Alexander Pertsemlidis
- Greehey Children's Cancer Research Institute, UT Health Science Center at San Antonio, San Antonio, Texas, United States of America
- Department of Cellular and Structural Biology, UT Health Science Center at San Antonio, San Antonio, Texas, United States of America
- Department of Pediatrics, UT Health Science Center at San Antonio, San Antonio, Texas, United States of America
- * E-mail:
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19
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Wang CYT, Arden KE, Greer R, Sloots TP, Mackay IM. A novel duplex real-time PCR for HPIV-4 detects co-circulation of both viral subtypes among ill children during 2008. J Clin Virol 2012; 54:83-5. [PMID: 22361219 DOI: 10.1016/j.jcv.2012.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 01/23/2012] [Indexed: 11/16/2022]
Abstract
The two subtypes of the human parainfluenzavirus type 4 (HPIV-4) are rarely sought in testing for acute respiratory illness (ARI) and this may be confounding our understanding of its role. This study presents a novel duplex real-time RT-PCR assay targeting the P gene that can detect and differentiate the two subtypes in a single reaction. Subtype-specific synthetic RNA positive controls were prepared and used to determine an analytical sensitivity of 10 copies per reaction with an 8log(10) dynamic range. The assays were validated using 1140 clinical specimens mostly nasopharyngeal aspirates collected from children during 2008. These included specimens previously determined to be positive for all commonly considered respiratory viruses. The novel assay did not cross-reaction with any other virus. Fourteen HPIV-4 positives, ten detected in the absence of any co-detections (four with rhinovirus), were identified in 2008 and their subtype confirmed by conventional RT-PCR and sequencing of P gene fragments. Most detections were in children two years of age or younger. Our assay proved suitably sensitive and specific for inclusion in future studies seeking to better understand the role HPIV-4 and other respiratory viruses in children with ARI.
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Affiliation(s)
- C Y T Wang
- Queensland paediatric infectious diseases Laboratory, Queensland Children's Medical Research Institute, Sir Albert Sakzewski Virus Research Centre, Children's Health Services District, University of Queensland, Australia
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20
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Greer R, Rahman J, Parfitt V. An unusual cause of confusion and hyponatraemia in an elderly patient. Acute Med 2012; 11:151-153. [PMID: 22993745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A large proportion of patients presenting on the acute medical take are frail and elderly and a significant proportion of these will have symptoms such as confusion, reduced mobility and electrolyte disturbances. These symptoms are typically attributed either to the iatrogenic effects of prescribed medications, disturbances in fluid balance and possible infective causes. We describe the case of a gentleman who presented with delirium, reduced mobility and hyponatraemia who was subsequently found to have pituitary failure secondary to pituitary apoplexy.
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Affiliation(s)
- R Greer
- FrenchayHospital Frenchay, Bristol, UK.
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21
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Du L, Subauste MC, Baker M, DeSevo C, Borkowski R, Zhong S, Schageman JJ, Greer R, Yang CR, Girard L, Gazdar AF, Wistuba II, Minna JD, Pertsemlidis A. Abstract 4709: miR-337-3p and its targets STAT3 and RAP1A modulate paclitaxel sensitivity in non-small cell lung cancers (NSCLCs). Cancer Res 2011. [DOI: 10.1158/1538-7445.am2011-4709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
We are addressing the questions of whether microRNAs (miRNAs) play a functional role in modulating drug sensitivity of lung cancer cells, and whether miRNA expression levels can be manipulated to increase drug sensitivity in lung cancer treatment. Using a combination of in silico and in vitro approaches, we identified miR-337-3p as a modulator of paclitaxel sensitivity in NSCLC cell lines where over-expression of miR-337-3p sensitizes NSCLC NCI-H1155 cells to paclitaxel (>2 fold) and docetaxel (>10 fold) by enhancing taxane-induced mitotic arrest. Of several possible targets of miR-337-3p we found that Stat3 and Rap1A are the direct targets responsible for mediating miR-337-3p sensitization to paclitaxel. In studies of multiple NSCLC lines we found that miR-337-3p can, in general, sensitize NSCLC lines to paclitaxel, and that Stat3 expression is significantly correlated with paclitaxel resistance in NSCLC lines, suggesting that tumor Stat3 expression is an intrinsic determinant and biomarker for paclitaxel response. We conclude we have discovered a novel pathway modulating NSCLC paclitaxel sensitivity, which involves the down-regulation of Stat3 and Rap1A expression by miR-337-3p. These findings have prompted: our ongoing studies of patient samples annotated for miR-337-3p, Stat3, and Rap1A expression and response to taxane therapy; preclinical testing of a miR-337-3p mimic as an adjuvant to taxanes for NSCLC therapy; and further tests of this pathway to provide both new therapeutic targets and biomarkers predictive of response for NSCLC taxane based therapy.
This research was supported by NIH R01 CA129632 from the National Cancer Institute and by P50 CA70907 from the UT Southwestern/MD Anderson Cancer Center Lung Specialized Program of Research Excellence.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4709. doi:10.1158/1538-7445.AM2011-4709
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Affiliation(s)
- Liqin Du
- 1UT Southwestern Medical Ctr., Dallas, TX
| | | | | | | | | | | | | | | | | | - Luc Girard
- 1UT Southwestern Medical Ctr., Dallas, TX
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Abstract
The Mooncup is a menstrual cup that is an alternative to conventional sanitary protection. We aimed to determine whether the Mooncup is tolerated by asking 53 healthy female volunteers to record the frequency of changing sanitary protection and leakage over three menstrual cycles with regular sanitary protection and three cycles with the Mooncup. We measured the frequency of leakage and changing the Mooncup along with acceptability of the Mooncup. A total of 126 baseline cycles and 71 cycles with the Mooncup were recorded. The Mooncup leaked 0.5 times less frequently and required to be changed 2.8 times less frequently, on average, during one menstrual period than regular sanitary protection. Of the participants, 55% will carry on using the Mooncup for sanitary protection. Thus, we have concluded that, the Mooncup is acceptable for most women but could not be used for the objective measurement of menstrual blood loss because of the leakage that did occur.
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Affiliation(s)
- K Stewart
- Department of Obstetrics and Gynaecology, Queens Medical Centre, Nottingham, UK.
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Dineen SP, Roland CL, Greer R, Carbon JG, Toombs JE, Gupta P, Bardeesy N, Sun H, Williams N, Minna JD, Brekken RA. Smac mimetic increases chemotherapy response and improves survival in mice with pancreatic cancer. Cancer Res 2010; 70:2852-61. [PMID: 20332237 DOI: 10.1158/0008-5472.can-09-3892] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Failure of chemotherapy in the treatment of pancreatic cancer is often due to resistance to therapy-induced apoptosis. A major mechanism for such resistance is the expression and activity of inhibitors of apoptosis proteins (IAP). Smac (second mitochondria-derived activator of caspase) is a mitochondrial protein that inhibits IAPs. We show that JP1201, a Smac mimetic, is a potent enhancer of chemotherapy in robust mouse models of pancreatic cancer. Combination of JP1201 with gemcitabine reduced primary and metastatic tumor burden in orthotopic xenograft and syngenic tumor models, induced regression of established tumors, and prolonged survival in xenograft and transgenic models of pancreatic cancer. The effect of JP1201 was phenocopied by XIAP small interfering RNA in vitro and correlated with elevated levels of tumor necrosis factor alpha protein in vivo. The continued development of JP1201 and other strategies designed to enhance therapy-induced apoptosis in pancreatic cancer is warranted.
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Affiliation(s)
- Sean P Dineen
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
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Affiliation(s)
- K Stewart
- Menstrual Disorder Clinic, Queens Medical Centre, Nottingham, UK
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Dineen S, Roland C, Greer R, Carbon J, Toombs J, Bardeesy N, Brekken R. 174. Inhibiting XIAP with SMAC Mimetic JP-1201 Increases Sensitivity to Gemcitabine and Improves Survival in Murine Models of Pancreatic Cancer. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Bhatta K, Greer R. Awareness and monitoring of tracheal tube cuff pressure in a multidisciplinary intensive care unit. Anaesth Intensive Care 2007; 35:302-3. [PMID: 17447298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Abstract
We tested the hypothesis that the number of surviving lambs counted in mid-summer from a Dall’s sheep ( Ovis dalli Nelson, 1884) population on Sheep Mountain, Yukon, Canada, is correlated to the density of snowshoe hares ( Lepus americanus Erxleben, 1777) in the surrounding boreal forest. We examined correlations between the number of lambs and the number of snowshoe hares at different phases in the 10-year snowshoe hare cycle. There were significant cross-correlations between the ratio of lambs to nursery sheep and hare densities with 1- and 2-year time lags. Lamb numbers also showed clockwise rotation with respect to hare densities when points were joined chronologically. Simple population models suggest several relationships: when hare densities are high, lamb population growth rates are inversely related to hare densities; during the low phase of the hare population cycle, lamb population growth rates show density-independent fluctuations. In the absence of compelling evidence for direct interactions between Dall’s sheep and hares, we hypothesize that the inverse relationship between lamb population growth and hare density is mediated indirectly by shared predators.
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Affiliation(s)
- J.F. Wilmshurst
- Parks Canada, 145 McDermot Avenue, Winnipeg, MB R3B 0R1, Canada
- Kluane National Park and Reserve, P.O. Box 5495, Haines Junction, YT Y0B 1L0, Canada
| | - R. Greer
- Parks Canada, 145 McDermot Avenue, Winnipeg, MB R3B 0R1, Canada
- Kluane National Park and Reserve, P.O. Box 5495, Haines Junction, YT Y0B 1L0, Canada
| | - J.D. Henry
- Parks Canada, 145 McDermot Avenue, Winnipeg, MB R3B 0R1, Canada
- Kluane National Park and Reserve, P.O. Box 5495, Haines Junction, YT Y0B 1L0, Canada
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Abstract
RATIONALE, AIMS AND OBJECTIVES To review critical incident reporting in UK intensive care units (ICUs). METHODS We conducted a postal survey of clinical directors of UK ICUs to ask if critical incident reporting was used in their ICU. Using a structured questionnaire, we also asked for details of critical incident reporting systems and for changes introduced as a result of incident reporting. RESULTS AND CONCLUSIONS Eighty-six of a total of 256 questionnaires were returned. Sixty-one units had been using a critical incident reporting system for a median duration of 3 years (interquartile range 2-5 years). There were wide variations in the structures of reporting systems between units. A median of four (interquartile range 3-8) critical incidents were reported per unit per month. In 141 changes, the development of protocols and guidelines (18) and changes in drug prescription and checking (20) were most common. A more consistent approach to reporting could improve patient care and 65 responders felt that a national reporting system was potentially useful.
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Affiliation(s)
- A N Thomas
- Intensive Care Medicine, Intensive Care Unit, Hope Hospital, Salford, UK.
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Russell WC, Greer R, Harper NJN. The effect of neuromuscular blockade on oxygen supply, consumption, and total chest compliance in patients with high oxygen requirements undergoing mechanical ventilation. Anaesth Intensive Care 2002; 30:192-7. [PMID: 12002927 DOI: 10.1177/0310057x0203000211] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We investigated the effects of neuromuscular blockade with atracurium on oxygen consumption, oxygen delivery and total chest compliance in 20 sedated intensive care patients who required mechanical ventilation with an inspired oxygen fraction of at least 0.6. The reverse Fick method was used to measure oxygen consumption. Total chest compliance was measured from the ventilator pneumotachograph and pressure transducer. Measurements were made before neuromuscular blockade, at a standard level of neuromuscular blockade, and after demonstrated recovery of neuromuscular function. There was no statistical difference in any of the parameters measured. However there were large changes in oxygen consumption (range -35% to +17%) and total chest compliance (range -19.7% to +9.7%) in individuals. We conclude that in the setting of critical oxygenation, neuromuscular blockade cannot be assumed to reduce oxygen requirements or improve total lung compliance. If, however, neuromuscular blockade is selected as an adjunct to therapy, we recommend that the indices of oxygenation are calculated.
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Affiliation(s)
- W C Russell
- Intensive Care Units, Leicester Royal Infirmary, UK
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Wadsworth R, Greer R, MacDonald JMS, Vohra A. The use of remifentanil during general anaesthesia for caesarean delivery in two patients with severe heart dysfunction. Int J Obstet Anesth 2002; 11:38-43. [PMID: 15321574 DOI: 10.1054/ijoa.2001.0910] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We describe the management of two patients with severe heart dysfunction requiring caesarean section because of incipient left ventricular failure. One patient had a bicuspid valve and developed symptoms of severe aortic incompetence during pregnancy. The second patient had known hypertrophic obstructive cardiomyopathy and developed chest pain and symptoms of left ventricular failure at 32 weeks' gestation. In both cases the worsening cardiac disease prompted the decision for operative delivery. We decided to employ general anaesthesia and achieved cardiovascular stability using remifentanil as an adjunct.
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Affiliation(s)
- R Wadsworth
- Saint Mary's Hospital for Women and Children, Whitworth Park, Manchester, UK.
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Abstract
We investigated the effects of peripheral oedema on the supramaximal current required for neuromuscular monitoring of critically ill patients. We studied 32 sedated patients who had not needed a neuromuscular blocking drug. The presence of oedema over the volar aspect of both wrists was assessed by a blinded observer and graded (grade 0, no oedema; grade 1, mild oedema; grade 2, gross oedema). The supramaximal current was derived by applying an incrementally increasing current over the ulnar nerve and measuring the amplitude of the electromyographic (EMG) response of the first dorsal interosseous muscle. The supramaximal current was that current above which there was no significant increase in EMG amplitude. It was 40 mA in the absence of oedema. This current was significantly increased in the presence of grade 1 oedema (60 mA, Mann-Whitney test, P<0.01) and grade 2 oedema (82.5 mA, Mann-Whitney test, P<0.01). In the presence of oedema, the required supramaximal current decreased significantly after the application of pressure over the stimulating electrodes (Wilcoxon signed rank test, P<0.05). Supramaximal current in critically ill patients is increased in the presence of peripheral oedema. We recommend that nerve stimulators used for neuromuscular monitoring in the ICU are capable of delivering a stimulus current of at least 100 mA.
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32
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Greer R, Severn A. Postherpetic neuralgia. Why burden the pain clinic? BMJ 2001; 322:861. [PMID: 11290645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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33
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Kapoor V, Greer R, Bazo A, Barnes DG. Transurethral vaporisation of the prostate. Anaesthesia 2000; 55:1036. [PMID: 11012522 DOI: 10.1046/j.1365-2044.2000.01727-23.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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34
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Greer R, Benson J. An assessment of attitudes to pulmonary artery flotation catheters in the United Kingdom and Ireland. Br J Anaesth 2000. [DOI: 10.1093/bja/84.5.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Triggs WJ, McCoy KJ, Greer R, Rossi F, Bowers D, Kortenkamp S, Nadeau SE, Heilman KM, Goodman WK. Effects of left frontal transcranial magnetic stimulation on depressed mood, cognition, and corticomotor threshold. Biol Psychiatry 1999; 45:1440-6. [PMID: 10356626 DOI: 10.1016/s0006-3223(99)00031-1] [Citation(s) in RCA: 121] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The pathophysiology of depression may include synaptic hypoactivity of left prefrontal cortex. Several groups of investigators have described improved mood associated with rapid transcranial magnetic stimulation (rTMS) but have not looked for possible cognitive side effects associated with left prefrontal magnetic stimulation. METHODS We measured the effects of left prefrontal rTMS on mood, cognition, and motor evoked potential threshold in 10 patients with medication-resistant major depression. RESULTS In a 2-week open trial of left prefrontal rTMS off antidepressant medications, scores on the Hamilton Rating Scale for Depression and the Beck Depression Inventory decreased by 41% and 40%, respectively. After resuming pre-rTMS antidepressant medication, improvement in mood was still significant at 1 and 3 months later. rTMS had no adverse effects on neuropsychological performance. rTMS treatments were associated with significant decreases in motor evoked potential threshold in the 9 of 10 patients who remained off psychotropic medications during the 2-week treatment period. CONCLUSIONS These preliminary data suggest that left prefrontal rTMS is safe and improves mood in patients with medication-resistant major depression. Changes in motor evoked potential threshold suggest that prefrontal rTMS may alter brain activity at sites remote from the stimulation. Double-blind, sham-controlled studies are needed.
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Affiliation(s)
- W J Triggs
- Human Motor Physiology Laboratory, University of Florida Health Science Center, Gainesville 32610-0236, USA
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Abstract
We have compared tactile assessment of the train-of-four (TOF) count and TOF ratio by nursing staff, with measurements made by a new acceleromyographic monitor, the TOF-Watch. We assessed neuromuscular block in 30 sedated intensive care patients receiving a continuous infusion of atracurium. Five nurses made a tactile assessment of neuromuscular block in each patient within a 5-min period. Each assessment was paired with a blinded TOF-Watch measurement. The nurses were accurate in assessing twitch count in 55% of measurements and they tended to overestimate the degree of block using tactile assessment of TOF ratio.
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Affiliation(s)
- R Greer
- Intensive Care Unit, Manchester Royal Infirmary
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Thomson MA, Storey P, Greer R, Cleghorn GJ. Canine-human transmission of Gastrospirillum hominis. Lancet 1994; 344:1097-8. [PMID: 7934483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Abstract
We report electron microscopic evidence of transmission from a pet dog to a 12-year-girl of Gastrospirillum hominis which caused gastric disease in both that was eradicable with treatment.
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Affiliation(s)
- M A Thomson
- Gastroenterology Unit, Royal Children's Hospital, Brisbane, Australia
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Quirk P, Greer R, Shepherd R, Cleghorn G. Serum immunoglobulin G directed against porcine trypsin in the serum of cystic fibrosis children receiving porcine pancreatic enzyme supplements. J Paediatr Child Health 1993; 29:196-200. [PMID: 8518002 DOI: 10.1111/j.1440-1754.1993.tb00486.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Cystic fibrosis (CF) patients require pancreatic enzyme replacement therapy to correct pancreatic insufficiency. These enzymes are derived from porcine pancreas and are known to be antigenic. To determine the possible clinical consequences, a specific ELISA was developed to detect IgG antibody directed against porcine trypsin (PTAb) in the sera of CF patients. The assay was used to evaluate the occurrence of PTAb in a cross sectional study of 103 CF patients in relation to the introduction of porcine enzyme therapy, clinical status and genotype. Antibodies against porcine trypsin were detected in the sera of 63% of patients unrelated to the age of commencement or the duration of enzyme therapy. No differences were observed in the clinical status of CF patients who had developed PTAb (n = 65) and those who had no detectable PTAb (n = 38) as determined from: the current prescribed dose of porcine pancreatic enzyme capsules; Z scores for height and weight; and respiratory function tests. It is suggested that the PTAb commonly found in the sera of CF patients are of doubtful clinical significance but the prospect of PTAb contributing to immune complex disease should be examined further.
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Affiliation(s)
- P Quirk
- Department of Child Health, University of Queensland, Royal Children's Hospital, Herston, Australia
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Abstract
Early deficits in nutritional status that might require specific treatment and early response to nutritional therapy were studied longitudinally in 25 infants with cystic fibrosis (CF) diagnosed by neonatal screening, using anthropometric and research body composition methodology, and evaluation of pancreatic function. At the time of confirmed diagnosis (mean 5.4 weeks), body mass, length, total body fat (TBF), and total body potassium (TBK) were all significantly reduced. Following diagnosis and commencement of therapy there was a normalization of weight, length, and TBK by 6-12 months of age, indicating catch-up growth. But in some individuals the response was incomplete, and as a group, mean total body fat remained significantly lower than normal at 1 year of age. Seven of 25 (28%) were pancreatic sufficient at diagnosis, and all but one had evidence of declining pancreatic function requiring the institution of pancreatic enzyme therapy during the next 1-9 months. The median age of commencement of enzyme therapy was 10 weeks (range 5 weeks to 11 months). These longitudinal assessments emphasize the dynamic changes occurring in absorptive function, body composition, and nutritional status following neonatal diagnosis of cystic fibrosis and may reflect previously described abnormalities of energy metabolism in this age group. Abnormal body composition is evident in most CF infants following diagnosis by neonatal screening but pancreatic damage may still be evolving. We suggest that early active nutritional therapy and surveillance for changes in pancreatic function are warranted in CF infants diagnosed by neonatal screening.
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Affiliation(s)
- R Greer
- Department of Pediatric Gastroenterology and Nutrition, Royal Children's Hospital, Brisbane, Queensland, Australia
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Abstract
Pancreatic exocrine dysfunction has been frequently recorded in protein-energy malnutrition in underdeveloped countries. In addition, the pancreas requires optimal nutrition for enzyme synthesis and potentially correctable pancreatic enzyme insufficiency may play a role in the continuation of protein-energy malnutrition. This problem has not been previously evaluated in Australian Aborigines. We have applied a screening test for pancreatic dysfunction (human immunoreactive trypsinogen [IRT] assay) to the study of 398 infants (6-36 months) admitted to the Alice Springs Hospital over a 20-month period. All infants were assessed by anthropometric measures and were assigned to three nutritional groups (normal, moderate or severely malnourished) and two growth groups (stunted or not stunted). Of the 198 infants who had at least a single serum cationic trypsinogen measurement taken, normal values for serum IRT (with confidence limits) were obtained from 57 children, who were normally nourished. IRT levels were significantly correlated with the degree of underweight but there was no correlation with the degree of stunting or age. Mean IRT levels for the moderate and severely underweight groups were significantly greater than the mean for the normal group (P less than 0.01). Seventeen children (8.6%) had trypsinogen levels in excess of the 95th percentile for the normally nourished group, reflecting acinar cell damage or ductal obstruction. We conclude that pancreatic dysfunction may be a common and important overlooked factor contributing to ongoing malnutrition and disease in malnourished Australian Aboriginal children.
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Affiliation(s)
- G J Cleghorn
- Children's Nutrition Research Centre, Department of Child Health, University of Queensland, Royal Children's Hospital, Brisbane
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Thomas BJ, Shepherd RW, Holt TL, Shepherd K, Greer R, Cleghorn GJ. Body composition studies in cystic fibrosis and myelomeningocele. Basic Life Sci 1990; 55:23-9. [PMID: 2088272 DOI: 10.1007/978-1-4613-1473-8_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- B J Thomas
- Department of Physics, Queensland University of Technology, Australia
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Abstract
To further evaluate the nature of malnutrition, define at-risk groups, and confirm the efficacy of nutritional supplementation on body composition in cystic fibrosis (CF), we have conducted longitudinal and cross-sectional studies of total body potassium (TBK) in 161 unselected CF subjects aged 1 month to 17 years. TBK was determined by measurement of 40K in a whole body counter, reflecting body cell mass (BCM), the vital work-performing and growing cellular component of the body. Compared with normal TBK data for age and sex from pooled measurements of 1,629 healthy children aged 1 week to 17 years, CF infants (n = 12) diagnosed by newborn screening were depleted in TBK at diagnosis and showed catch-up with therapy by 1 year; CF children aged 2-17 years (n = 140) showed a tendency for inadequate accretion of TBK (and thus BCM) with increasing age, although the normal correlation between TBK and weight and height was maintained in the majority suggesting a pattern of nutritional stunting of growth; and malnourished CF children (n = 9) showed significant catch-up in TBK with long-term nutritional rehabilitation (85-98% of TBK predicted for weight and height). These studies suggest that potentially serious, but possibly correctable deficits, in the growth of the body cell mass as measured by TBK occur commonly in CF. These deficits may be established very early in life and if not corrected lead to progressive nutritional growth retardation with increasing age.
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Affiliation(s)
- R W Shepherd
- Department of Gastroenterology and Nutrition, Royal Children's Hospital, Brisbane, Queensland, Australia
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Little HL, Sacks A, Vassiliadis A, Greer R. Current concepts of pathogenesis of diabetic retinopathy: a dysproteinemia. Trans Am Ophthalmol Soc 1977; 75:397-426. [PMID: 613527 PMCID: PMC1311558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Sane S, Yunis E, Greer R. Subperiosteal or cortical cyst and intramedullary neurofibromatosis--uncommon manifestations of neurofibromatosis. A case report. J Bone Joint Surg Am 1971; 53:1194-200. [PMID: 4999155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Weber J, Greer R, Voight B, White E, Roy R. Unusual strength properties of echinoderm calcite related to structure. J Ultrastruct Res 1969; 26:355-66. [PMID: 5776310 DOI: 10.1016/s0022-5320(69)90043-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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